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ORMC's trauma rules up for review

Spectators listen as the the Florida Department of Health Office of Trauma conducts a public hearing about rules concerning the placement of trauma centers at the Marion County Health Department in Ocala on Friday.

Published: Friday, February 8, 2013 at 7:22 p.m.

Last Modified: Friday, February 8, 2013 at 7:22 p.m.

Dozens of local health care, emergency and elected officials pleaded during a workshop Friday that the Department of Health not close Ocala Regional Medical Center's new trauma center while the state develops new rules for how such facilities should be approved in the future.

Facts

Taking advice

The Department of Health late Friday announced it will immediately follow some recommendations from outside trauma care experts. It will:• Incorporate performance improvement processes into all aspects of the trauma program.• Work with the Florida Department of Transportation to request a National Highway Traffic Safety Administration EMS Reassessment.• Move forward with implementation of the Next Generation Trauma Registry.

The center is operating with a provisional licence, and in about a year is slated to receive its permanent verification permit.

Shands at the University of Florida in Gainesville, whose Level 1 trauma center previously accepted most of Marion County's trauma patients, said Ocala Regional's Level 2 trauma center doesn't provide patients any better care just because of its location.

In fact, Shands officials said the new trauma center only ends up pilfering the limited number of available trauma staff from other existing trauma centers, and will likely take about one-third of Shands' trauma patients — thus reducing Shands' ability to get grants as a top-notch research facility.

The arguments about the trauma center, which already has served about 300 patients since opening late last year, are part of a larger story that the Department of Health is addressing through a series of public workshops. Friday's was held at the Marion County Health Department building in Ocala.

The meetings are designed to help the department develop new rules regulating the creation of trauma centers.

The issue is important to Marion County because of Ocala Regional's trauma center, which is the target of a recent lawsuit by Munroe Regional Medical Center, Shands at UF and Shands Jacksonville Medical Center. The suit challenges the Department of Health's decision last year to allow Ocala Regional to open its trauma center.

While the legal dispute rages, Florida State Surgeon General John Armstrong opened Friday's workshop by asking the 80 or so attendees to make peace, move toward "reconciliation," and focus on the task at hand: deciding which factors the Department of Health should incorporate when developing new guidelines for approving new trauma centers.

"We will not be stuck looking in the rear view mirror," Armstrong said, making reference to the pending lawsuit and similar challenges.

In that spirit, Department of Health officials Victor Johnson and Lisa VanderWerf-Hourigan asked attendees what rules they wanted used in determining future trauma centers.

Despite those entreaties, the workshop from the beginning was chock-full of testimonials from trauma patients, health care and emergency workers and politicians asking the state to keep the Ocala trauma center open.

Marion County Fire Rescue Chief Stuart McElhaney was one of many emergency workers who reported that the new trauma center reduced the time it takes to get severely injured patients the advanced care they need.

Transporting patients to Shands' trauma center in Gainesville by ambulance took an average of 41.4 minutes; driving them to Ocala Regional takes, on average, about 15 minutes, he said.

"That's not a good number," McElhaney said of the drive to Shands.

Of the 65,612 emergency calls Marion County Fire Rescue responded to last year, about 17 percent were trauma patients.

"Prior to the opening of the trauma center in Marion County, trauma Service Area 6 (which includes Marion, Citrus and Hernando counties) ranked highest for the most patients transferred to other areas to receive trauma care," McElhaney said.

Dereck Welch was among the first local trauma patients to be treated in Ocala.

Welch had an aneurysm in an artery leading to his spleen. While at another Marion County health facility to fix it, complications developed and Welch began bleeding internally.

"They called the ambulance to take me to Ocala Regional and I died in the ambulance. The bleeding was so bad my … heart stopped again on the operating (table)," said Welch, 53.

Dr. Darwin Ang, Ocala Regional trauma center director, said his center's around-the-clock surgical team was equipped and trained to identify the medical problem and respond.

As for taking him to Shands, Ang said, "He didn't have the time for that."

Nancy Romeo, whose son was hit on his motorcycle by a dump truck Jan. 15 and taken to Ocala's trauma center with life-threatening injuries, also came to the workshop to explain how the center saved her son's life.

After leaving the meeting, she said the lawsuit challenging DOH's approval of the Ocala trauma center was "ridiculous."

"I'm livid. I'm absolutely livid," Romeo said. "They're not even thinking about the people (the trauma center helps)."

State Rep. Dennis Baxley told state officials that those objecting to the trauma center should prove why it should be closed, rather than putting the community in the position of having to prove why it should remain open.

"I think it would be a serious mistake to move backward (and close the center)," said Baxley, R-Ocala.

But Fred Moore, medical director of trauma services at Shands, said the distance between Ocala and Gainesville wasn't enough to warrant a trauma center here.

"The motivation (of Ocala Regional) is not to provide better care … but to make money," he said of the new trauma center and some others opening in Florida.

Such a reduction will make it more difficult for Shands to secure grants and keep its staff at peak performance, Moore said.

As a Level 1 facility, Shands incorporates an educational component into its service as well as other medical specialties not featured at a Level 2 center like Ocala's.

The dispute over Ocala Regional's trauma center stems from a series of legal maneuvers involving the Department of Health; Ocala Regional's parent company, Hospital Corporation of America (HCA); and other hospitals.

In 2004 the Florida Legislature told the Department of Health to update its rules concerning trauma centers. The rules had not changed since 1992.

But the department did not act. And in September 2011 an administrative law judge found that the department rules for determining the location and need for trauma centers were invalid.

In November the 1st District Court of Appeal upheld that ruling. But the Department of Health granted Ocala Regional its provisional status before the appellate court's decision technically took effect — allowing the new trauma center to slip in just under the legal wire.

Munroe Regional also applied for permission to open a trauma center but was denied.

Ocala Regional's trauma center is the only such facility in Marion or Citrus counties.

Seann Frazier, a Shands lawyer helping prosecute the lawsuit, said the Department of Health ignored the law when it issued the permits to Ocala Regional and other trauma centers.

Although every county would like a trauma center, "the truth is there just aren't enough trauma surgeons … to have trauma centers everywhere," he said.

About 95 percent of Floridians have timely access to trauma care. Shands also has a helicopter in Marion County to ensure faster transport to Gainesville, Frazier said during Friday's workshop.

A second trauma center also siphons the limited trauma staff available for Shands, he said. The Ocala startup recently forced Shands to pay its trauma staff about $800,000 more annually to prevent attrition.

Ang, the Ocala Regional trauma center director, said the debate is about more than statistics.

"I know the trauma center would save lives," he said. "Simply, there is a need."

Ang said many trauma patients get good care at Shands, "but what about the patients who didn't make it?"

As for diluting the trauma workforce, Ang said, "we look at it as job creation."

<p>Dozens of local health care, emergency and elected officials pleaded during a workshop Friday that the Department of Health not close Ocala Regional Medical Center's new trauma center while the state develops new rules for how such facilities should be approved in the future.</p><p>The center is operating with a provisional licence, and in about a year is slated to receive its permanent verification permit.</p><p>Shands at the University of Florida in Gainesville, whose Level 1 trauma center previously accepted most of Marion County's trauma patients, said Ocala Regional's Level 2 trauma center doesn't provide patients any better care just because of its location.</p><p>In fact, Shands officials said the new trauma center only ends up pilfering the limited number of available trauma staff from other existing trauma centers, and will likely take about one-third of Shands' trauma patients — thus reducing Shands' ability to get grants as a top-notch research facility.</p><p>The arguments about the trauma center, which already has served about 300 patients since opening late last year, are part of a larger story that the Department of Health is addressing through a series of public workshops. Friday's was held at the Marion County Health Department building in Ocala.</p><p>The meetings are designed to help the department develop new rules regulating the creation of trauma centers.</p><p>The issue is important to Marion County because of Ocala Regional's trauma center, which is the target of a recent lawsuit by Munroe Regional Medical Center, Shands at UF and Shands Jacksonville Medical Center. The suit challenges the Department of Health's decision last year to allow Ocala Regional to open its trauma center.</p><p>While the legal dispute rages, Florida State Surgeon General John Armstrong opened Friday's workshop by asking the 80 or so attendees to make peace, move toward "reconciliation," and focus on the task at hand: deciding which factors the Department of Health should incorporate when developing new guidelines for approving new trauma centers.</p><p>"We will not be stuck looking in the rear view mirror," Armstrong said, making reference to the pending lawsuit and similar challenges.</p><p>In that spirit, Department of Health officials Victor Johnson and Lisa VanderWerf-Hourigan asked attendees what rules they wanted used in determining future trauma centers.</p><p>Despite those entreaties, the workshop from the beginning was chock-full of testimonials from trauma patients, health care and emergency workers and politicians asking the state to keep the Ocala trauma center open.</p><p>Marion County Fire Rescue Chief Stuart McElhaney was one of many emergency workers who reported that the new trauma center reduced the time it takes to get severely injured patients the advanced care they need.</p><p>Transporting patients to Shands' trauma center in Gainesville by ambulance took an average of 41.4 minutes; driving them to Ocala Regional takes, on average, about 15 minutes, he said.</p><p>"That's not a good number," McElhaney said of the drive to Shands.</p><p>Of the 65,612 emergency calls Marion County Fire Rescue responded to last year, about 17 percent were trauma patients.</p><p>"Prior to the opening of the trauma center in Marion County, trauma Service Area 6 (which includes Marion, Citrus and Hernando counties) ranked highest for the most patients transferred to other areas to receive trauma care," McElhaney said.</p><p>Dereck Welch was among the first local trauma patients to be treated in Ocala.</p><p>Welch had an aneurysm in an artery leading to his spleen. While at another Marion County health facility to fix it, complications developed and Welch began bleeding internally.</p><p>"They called the ambulance to take me to Ocala Regional and I died in the ambulance. The bleeding was so bad my … heart stopped again on the operating (table)," said Welch, 53.</p><p>Dr. Darwin Ang, Ocala Regional trauma center director, said his center's around-the-clock surgical team was equipped and trained to identify the medical problem and respond.</p><p>As for taking him to Shands, Ang said, "He didn't have the time for that."</p><p>Nancy Romeo, whose son was hit on his motorcycle by a dump truck Jan. 15 and taken to Ocala's trauma center with life-threatening injuries, also came to the workshop to explain how the center saved her son's life.</p><p>After leaving the meeting, she said the lawsuit challenging DOH's approval of the Ocala trauma center was "ridiculous."</p><p>"I'm livid. I'm absolutely livid," Romeo said. "They're not even thinking about the people (the trauma center helps)."</p><p>State Rep. Dennis Baxley told state officials that those objecting to the trauma center should prove why it should be closed, rather than putting the community in the position of having to prove why it should remain open.</p><p>"I think it would be a serious mistake to move backward (and close the center)," said Baxley, R-Ocala.</p><p>But Fred Moore, medical director of trauma services at Shands, said the distance between Ocala and Gainesville wasn't enough to warrant a trauma center here.</p><p>"The motivation (of Ocala Regional) is not to provide better care … but to make money," he said of the new trauma center and some others opening in Florida.</p><p>Moore predicted that Shands' trauma volume — about 2,500 patients annually — will fall by one-third because of Ocala's trauma center.</p><p>Such a reduction will make it more difficult for Shands to secure grants and keep its staff at peak performance, Moore said.</p><p>As a Level 1 facility, Shands incorporates an educational component into its service as well as other medical specialties not featured at a Level 2 center like Ocala's.</p><p>The dispute over Ocala Regional's trauma center stems from a series of legal maneuvers involving the Department of Health; Ocala Regional's parent company, Hospital Corporation of America (HCA); and other hospitals.</p><p>In 2004 the Florida Legislature told the Department of Health to update its rules concerning trauma centers. The rules had not changed since 1992.</p><p>But the department did not act. And in September 2011 an administrative law judge found that the department rules for determining the location and need for trauma centers were invalid.</p><p>In November the 1st District Court of Appeal upheld that ruling. But the Department of Health granted Ocala Regional its provisional status before the appellate court's decision technically took effect — allowing the new trauma center to slip in just under the legal wire.</p><p>Munroe Regional also applied for permission to open a trauma center but was denied.</p><p>Ocala Regional's trauma center is the only such facility in Marion or Citrus counties.</p><p>Seann Frazier, a Shands lawyer helping prosecute the lawsuit, said the Department of Health ignored the law when it issued the permits to Ocala Regional and other trauma centers.</p><p>Although every county would like a trauma center, "the truth is there just aren't enough trauma surgeons … to have trauma centers everywhere," he said.</p><p>About 95 percent of Floridians have timely access to trauma care. Shands also has a helicopter in Marion County to ensure faster transport to Gainesville, Frazier said during Friday's workshop.</p><p>A second trauma center also siphons the limited trauma staff available for Shands, he said. The Ocala startup recently forced Shands to pay its trauma staff about $800,000 more annually to prevent attrition.</p><p>Ang, the Ocala Regional trauma center director, said the debate is about more than statistics.</p><p>"I know the trauma center would save lives," he said. "Simply, there is a need."</p><p>Ang said many trauma patients get good care at Shands, "but what about the patients who didn't make it?"</p><p>As for diluting the trauma workforce, Ang said, "we look at it as job creation."</p><p>"We're not invading a market and repeating (what's already there)," he said. "We're bringing in something new."</p><p><i>Contact Fred Hiers at 867-4157 or fred.hiers@starbanner.com.</i></p>